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Under health reform, Americans who earn up to 133 percent of the federal poverty level will qualify for Medicaid starting 2014. States will have to expand their programs to stay in the federal-state health care program for the poor. The administration points out that states’ Medicaid participation is voluntary. But states say it’s voluntary in name only. Medicaid, one of their biggest budget items, has become such a force in coverage that it would be practically impossible for a state to opt out.

The court’s decision to pick up the Medicaid piece caught many legal experts by surprise since no lower court ruled against it. The courts have generally said the feds can use money — such as the federal share of Medicaid funds — to influence state activities.

But should the Supreme Court side with the states, it could have huge implications for Congress’s spending power and ability to place conditions on the states, Joondeph said. So why hasn’t the Medicaid challenge gotten more attention?

“One, the mandate is more controversial politically,” Joondeph said. “And two, people think the mandate question is closer and the court is more likely to invalidate the mandate.”

The wild card: Anti-Injunction Act

There’s a possible legal landmine that could make everyone wait years for a definitive ruling. That possibility comes courtesy of the 4th Circuit Court of Appeals, which ruled in August it couldn’t decide on the individual mandate until people have to pay its penalties in 2015. That’s because of the esoteric Anti-Injunction Act, a strictly nonpartisan law that says that individuals can’t actually challenge a tax in court before they have to pay it.

The justices originally planned for 60 minutes of oral arguments on the AIA, but they pushed it to 90 minutes, giving more time to explore the issue. There’s not a lot of AIA precedent to draw on, so it’s hard to predict where the judges may fall on this question.

After two years of litigating health care reform, neither side wants to see this drawn out further. Both the Justice Department and law’s opponents have argued that the AIA doesn’t apply in this case, and it’s safe to say the country wants to see this case resolved as soon as possible.

But those preferences won’t matter much to justices, says Kevin Walsh, a University of Richmond law professor and former clerk for Justice Antonin Scalia.

“Jurisdictional matters need to be addressed by the court no matter what the parties think,” Walsh said.

I think that health care reform is a great idea. I have type 1 diabetes and for me to get insurance, it was a nightmare until I found "Penny Health" search for them online and you can get affordable health insurance instantly.

Great, so therefore you must support universal healthcare (expansion of Medicare) or a public option. This HC bill was the compromise because (mostly) Republicans wouldn't support anything else that addressed the fact that the uninsured are making us pay for their emergency care (and poorer health for lack of affordable preventive care).

Or, you support letting HC providers to turn away uninsured emergency room victims. "Sorry, go find a church or something".

This law was not put forth to appease the Republicans and not one voted for it.

The uninsured are a problem but this law does nothing to solve that problem, as it subsidizes large numbers of people with tax dollars. How is that any different from what the current system (mess) forces us to do, subsidize those who can't/won't take care of themselves?

Last month Obama's acting budget director, Jeffrey Zients, testified before Congress that the penalty imposed on those who do not purchase health insurance does not constitute a tax.

So...this is the rule and how Medicare Part D is intrepeted/implemented...........if a senior 65+ does not enroll in medicare part D within a prescribed enrollment period penalty will be imposed........right?

"That’s because of the esoteric Anti-Injunction Act, a strictly nonpartisan law that says that individuals can’t actually challenge a tax in court before they have to pay it."

pretty simple: obumbocare makes NO reference to the mandate being a tax (see also the Vinson decision), odumbo on the George Stephanopoulos (sp) ardently stated it was NOT a tax (didn't want to be seen raising taxes).

If it's NOT a tax, AIA does NOT apply. Possible problems: the Affordable Care Act is NOT affordable and the Patient Protection part does NOT protect patients.

I certainly hope they strike the bill down in its entirety and not leave us to suffer with it! Have you read it, or talked to someone who has? Your doctor, perhaps? It is a poorly crafted piece of legislation which escalates costs instead of lowering them as it claimed. That's because it doesn't address the cost drivers in medicine except to add insult to injury! Even before the full implementation of Obamacare, doctors are retiring and fleeing in droves. Bad for patients. Some smaller hospitals are closing. Bad for patients. Employers can't afford the more expensive insurance required under Obamacare and aren't expanding if not shrinking, bad for jobs and patients. Insurance companies are raising premiums because of Obamacare's expensive requirements: bad for patients. Bad for jobs if those companies fold. Even the public option isn't attractive: I've been on public and private and there is NO comparison in quality of care. Bad for patients. And of course, the costs will be astronomically higher than projected like every other government program, which taxpayers get to cover. Bad for everyone!

The current law also says that come August 1 now, 2012, Medicare will no longer reimburse individuals involved in care, but give out a certain amount based solely upon diagnosis. This amount of money would not change based upon severity of the disease, length of stay, extra testing, etc. That means all doctors (and the hospital) will have to divide up the money in some way hopefully reflective of care given, and the result is projected to halve doctors' pay to a little over $100k. This might not be a big deal were medical education so long and expensive and malpractice so high. But Obamacare lacks any tort reform, so medical costs will continue to be high so that doctors can assure lawyers in court that they did everything possible to care for their patients, including unnecessary expensive tests and labs. Not that I blame them for not wanting to get their butts sued off. I blame Obamacare for leaving out changes to the biggest cost driver in medicine, but what do you expect from a bunch of lawyers?